Use of Bromocriptine in the Management of Peripartum Cardiomyopathy: A Systematic Review and Meta-analysis

Background: Peripartum cardiomyopathy (PPCM) is the onset of heart failure during the last month of pregnancy or the first 5 months postpartum in a previously healthy woman. Roles of prolactin metabolites, possibly cardiotoxic in humans, in the pathogenesis of this disease has been verified. In some studies, medical treatment with Bromocriptine (a dopamine agonist able to inhibit prolactin) associated with standard therapy has shown beneficial effects including improvement of left ventricular ejection fraction in patients with PPCM. However, no previous systematic review has proven its place in the optimal management of these patients. Methods: We performed a literature review to identify randomized and, nonrandomized clinical studies that reported the use of bromocriptine in the management of PPCM in addition to standard heart failure regimen compared to standard heart failure regimen alone. A total of 9 databases containing articles from January 1, 2000 to July 31, 2017 were analyzed, including MEDLINE, Embase, Cochrane, DARE and Scopus. Results: We identified and screened 410 potentially eligible publications through the databases. Based on our inclusion and exclusion criteria, From the 410 potential publications through the databases, 4 studies for a total of 263 patients were included in this analysis: two randomized control trials and two prospective studies that investigated the effect of bromocriptine in the management of acute PPCM. Compared with the control (standard therapy for heart failure alone), bromocriptine when combined with standard therapy improved the left ventricle ejection fraction by 11.37% (MD 11.37, 95% confidence interval [CI]: 9.55-13.19 p=0.001) after 6 months compared to standard therapy alone. In addition, no thromboembolic events were reported in any of the 263 patients. Conclusion: Peripartum cardiomyopathy is a rare but serious condition that affects childbearing women. The present study showed that bromocriptine has a therapeutic effect in the clinical outcomes of women with PPCM.